AHRQ Stats: Diabetes Care for Children and Young Adults

Children and young adults from the poorest communities were nearly three times as likely as those from wealthier communities to get emergency department care for diabetes in 2012. Medicaid was the primary payer for more than 40 percent of diabetes-related emergency department visits. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #203: Emergency Department Visits for Children and Young Adults With Diabetes, 2012.)

April 2016

Emergency Department Visits for Children and Young Adults With Diabetes, 2012

Aitalohi Amaize, M.P.H., B.S.N., R.N., C.E.N., and Kamila B. Mistry, Ph.D., M.P.H.

Introduction

Diabetes is an important public health concern in the United States, affecting an estimated 29.1 million people, or 9.3 percent of the population.¹ Among children and young adults, diabetes is one of the most common chronic diseases, and prevalence increases with age. Recent data estimate that 208,000 people under the age of 20 years have a diagnosis of diabetes.¹ In 2011, of adults newly diagnosed with diabetes, 4.3 percent were aged 18-29 years.²

In both children and adults, diabetes is optimally managed in the outpatient setting. However, the emergency department (ED) represents a point of health care access for those with acute symptoms related to chronic conditions. A large number of ED visits are nonurgent and potentially preventable with optimal access to quality primary care.³ Patients presenting to the ED can be treated and released or admitted to the hospital.

Undetected or poorly controlled diabetes can lead to increased ED utilization and subsequent hospitalization due to serious complications (including cardiovascular disease, kidney damage, blindness, and lower-limb amputations due to peripheral vascular disease). In adults, diabetes and related complications account for around $176 billion in direct medical costs, which is 2.3 times higher than medical costs of adults without diabetes.¹ Data have shown significant increases in diabetes-related hospitalizations in young adults aged 20-29 years.⁴

This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents 2012 data on diabetes-related ED visits among children and young adults aged 0-29 years. Variations in overall ED visits, treat-and-release ED visits, and ED visits resulting in hospital admission are presented by demographic, regional, and payer characteristics, and diagnostic-specific differences are also presented. All differences between estimates noted in the text are statistically significant at the .05 level or better.

Findings

Overall diabetes-related ED visits in children and young adults, 2012
Table 1 presents characteristics of children and young adults with diabetes who were seen in the ED in 2012. Children and young adults accounted for over 587,000 diabetes-related ED visits (defined as having a diabetes diagnosis listed in the patient's discharge record).

Highlights

In 2012, 587,300 diabetes-related ED visits were for children and young adults aged 0-29 years. Most of these patients were treated and released (76.5 percent), and the remaining 23.5 percent were admitted to the hospital.

Diabetes-related ED visit rates were higher among young adults aged 18-29 years (905 per 100,000 U.S. population) compared with children aged 0-17 years (149 per 100,000 U.S. population).

Diabetes-related ED visits were higher among patients from the lowest income communities (278 per 100,000 U.S. population) than from the highest income communities (94 per 100,000 U.S. population).

Medicaid was the primary expected payer for 40 percent of diabetes-related ED visits.

Ketoacidosis was the most common complication among children and young adults in the ED with uncontrolled diabetes, accounting for approximately one out of seven diabetes-related ED visits in this age group.

One out of five diabetes-related ED visits by children and young adults was coded as uncontrolled diabetes, and over two-thirds of these visits resulted in hospital admission.